Prescribing methadone as part of opioid agonist therapy is a common treatment approach to manage opioid use disorder. Unfortunately, many clients prematurely discontinue opioid agonist therapy because of restrictions attached to the therapy.
Purpose
The purpose of this study was to explore health-care provider experiences as they worked with clients on opioid agonist therapy in a western Canadian city.
Methods
In this descriptive, qualitative study, we interviewed 18 health-care providers working in an opioid agonist therapy setting. The focus of the interviews was on the organization of opioid agonist therapy care at their clinic, their personal experiences and challenges faced when providing care to their clients. Interviews were recorded electronically and transcribed verbatim and thematic analysis was completed using NVIVO software.
Results
The following three themes emerged from the data relate to the care organization and health care provider (HCP)-clients dynamics. These are: (1) fragmentation of care for a complex problem, (2) enforcing compliance to treatment, and (3) the importance of a therapeutic alliance to improve overall care.
Conclusion
The opioid agonist therapy model is biocentric and emphasizes abstinence which can create tension between providers and clients. Making the model of care more patient centred might help to improve client retention rates and successful treatment outcomes.
AllmanD.MyersT.SchellenbergJ.StrikeC.CockerillR.CavalieriW. (2007).
Improving health and social care relationships for harm reduction. International Journal of Drug Policy,
18(3), 194–203.
2.
BarryD. T.IrwinK. S.JonesE. S.BeckerW. C.TetraultJ. M.SullivanL. E., . . . FiellinD. A. (2010).
Opioids, chronic pain, and addiction in primary care. The Journal of Pain,
11(12), 1442–1450.
3.
BrandsB.BlakeJ.MarshD. C.SprouleB.JeyapalanR.LiS. (2008).
The impact of benzodiazepine use on methadone maintenance treatment outcomes. Journal of Addictive Diseases,
27(3), 37–48.
4.
BrookmanC.JakobL.DeCiccoJ.BenderD. (2011). Client-centered care in the Canadian home and community sector: A review of key concepts.
Markham, ON:
Saint Elizabeth.
5.
BurbridgeA. M. M.CampbellM. A. (2012). Evaluating methadone maintenance treatment outcomes in an Atlantic Canadian milieu (Doctoral dissertation). University of New Brunswick, Fredericton, New Brunswick.
6.
Canadian Institute for Health Information, Canadian Centre on Substance Abuse. (2016). Hospitalizations and emergency department visits due to opioid poisoning in Canada.
Ottawa, ON:
Author.
7.
DadzieG.AziatoL.AikinsA. D. G. (2017).
We are the best to stand in for patients: A qualitative study on nurses’ advocacy characteristics in Ghana. BMC Nursing,
16(1), 61.
8.
DavoodvandS.AbbaszadehA.AhmadiF. (2016).
Patient advocacy from the clinical nurses' viewpoint: A qualitative study. Journal of Medical Ethics and History of Medicine,
9. pp.1–8. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4958925/
9.
DeverC. (2017).
Treating acute pain in the opioid-dependent patient. Journal of Trauma Nursing,
24(5), 292–299.
10.
de MaeyerJ.VanderplasschenW.CamfieldL.VanheuleS.SabbeB.BroekaertE. (2011).
A good quality of life under the influence of methadone: A qualitative study among opioid-dependent individuals. International Journal of Nursing Studies,
48(10), 1244–1257.
11.
Faggiano, F., Vigna-Taglianti, F., Versino, E., & Lemma. P. (2003). Methadone maintenance at different dosages for opiod dependence. The Cochrane Database of Systematic Reviews, Issue 3. Art. No.: CD002208. DOI: 10.1002/14651858.CD002208.
12.
FischerB.KurdyakP.GoldnerE.TyndallM.RehmJ. (2016).
Treatment of prescription opioid disorders in Canada: Looking at the ‘other epidemic’?Substance Abuse Treatment, Prevention, and Policy,
11(1), 12.
13.
FischerJ.NealeJ.BloorM.JenkinsN. (2008).
Conflict and user involvement in drug misuse treatment decision-making: A qualitative study. Substance Abuse Treatment, Prevention, and Policy,
3(1), 21. doi:10.1186/1747-597X-3-21
14.
FordR. (2011).
Interpersonal challenges as a constraint on care: The experience of nurses’ care of patients who use illicit drugs. Contemporary Nurse,
37(2), 241–252.
15.
GaleN. K.HeathG.CameronE.RashidS.RedwoodS. (2013).
Using the framework method for the analysis of qualitative data in multi-disciplinary health research. BMC Medical Research Methodology,
13(1), 117.
16.
GowingL. R.HickmanM.DegenhardtL. (2013).
Mitigating the risk of HIV infection with opioid substitution treatment. Bulletin of the World Health Organization,
91(2), 148–149.
17.
GowingL.FarrellM.BornemannR.SullivanL.AliR. (2008). Substitution treatment of injecting opioid users for prevention of HIV infection. Cochrane Database Systematic Review 2. Art. No.: CD004145. DOI: 10.1002/14651858.CD004145.pub3.
18.
GrosD. F.MilanakM. E.BradyK. T.BackS. E. (2013).
Frequency and severity of comorbid mood and anxiety disorders in prescription opioid dependence. The American Journal on Addictions,
22(3), 261–265.
19.
GuarinoH. M.MarschL. A.Campbell IiiW. S.GarganoS. P.HallerD. L.SolhkhahR. (2009).
Methadone maintenance treatment for youth: Experiences of clients, staff, and parents. Substance Use & Misuse,
44(14), 1979–1989.
HserY.EvansE.GrellaC.LingW.AnglinD. (2015).
Long-term course of opioid addiction. Harvard Review of Psychiatry,
23(2), 76–89.
22.
KolindT.HesseM. (2017).
Patient‐centred care—Perhaps the future of substance abuse treatment. Addiction,
112(3), 465–466.
23.
Kramer, M. H. H., Bauer, W., Dicker, D., Durusu-Tanriover, M., Ferreira, F., Rigby, S. P., … & van Hulsteijn, J. H. (2014). The changing face of internal medicine: patient centred care. European journal of internal medicine, 25(2), 125–127.
24.
LevitL. A.BaloghE.NassS. J.GanzP. (Eds.) (2013). Delivering high-quality cancer care: Charting a new course for a system in crisis.
Washington, DC:
National Academies Press.
25.
LiX. L.TanH. Z.SunZ. Q.ZhangH.ChenM. S.OuQ. Y. (2009).
Study on the time of retention and related influencing factors of patients receiving methadone maintenance treatment in Hunan province. Zhonghua Liu Xing Bing Xue za Zhii,
30(7), 672–675.
26.
McCoyL. (2005).
HIV-positive patients and the doctor-patient relationship: Perspectives from the margins. Qualitative Health Research,
15(6), 791–806.
27.
MancinoM.CurranG.HanX.AlleeE.HumphreysK.BoothB. M. (2010).
Predictors of attrition from a national sample of methadone maintenance patients. The American Journal of Drug and Alcohol Abuse,
36(3), 155–160.
28.
MattickR. P.BreenC.KimberJ.DavoliM. (2009).
Methadone maintenance therapy versus no opioid replacement therapy for opioid dependence. Cochrane Database Systematic Review,
3(3). Art. No.: CD002209. DOI: 10.1002/14651858.CD002209.pub2.
29.
MeadN.BowerP. (2000).
Patient-centredness: A conceptual framework and review of the empirical literature. Social Science & Medicine,
51(7), 1087–1110.
MonksR.ToppingA.NewellR. (2013).
The dissonant care management of illicit drug users in medical wards, the views of nurses and patients: A grounded theory study. Journal of Advanced Nursing,
69(4), 935–946.
32.
MooreD. (2011).
The benevolent watch: Therapeutic surveillance in drug treatment court. Theoretical Criminology,
15(3), 255–268.
33.
NevilleK.RoanN. (2014).
Challenges in nursing practice: Nurses’ perceptions in caring for hospitalized medical-surgical patients with substance abuse/dependence. Journal of Nursing Administration,
44(6), 339–346.
34.
PatraJ. (2007). Barriers to retention in the Toronto Drug Treatment Court Program: What provides the impetus to succeed or to fail? ProQuest. PhD thesis-UMI no NR 27972
35.
PaulyB. B.GoldstoneI.McCallJ.GoldF.PayneS. (2007).
The ethical, legal and social context of harm reduction. The Canadian Nurse,
103(8), 19.
36.
PressK. R.ZornbergG. Z.GellerG.CarreseJ.FingerhoodM. I. (2016).
What patients with addiction disorders need from their primary care physicians: A qualitative study. Substance Abuse,
37(2), 349–355.
37.
SamaanZ.BaworM.DennisB. B.PlaterC.VarenbutM.DaiterJ. . . . , ThabaneL. (2014).
Genetic influence on methadone treatment outcomes in patients undergoing methadone maintenance treatment for opioid addiction: A pilot study. Neuropsychiatric Disease and Treatment,
10, 1503–1508.
ThompsonL.McCabeR. (2012).
The effect of clinician-patient alliance and communication on treatment adherence in mental health care: A systematic review. BMC Psychiatry,
12(1), 87.
WalkinshawE. (2011).
Patient navigators becoming the norm in Canada. Canadian Medical Association Journal,
183(15), E1109–E1110.
45.
WhiteW. L.CampbellM. D.SpencerR. D.HoffmanH. A.CrissmanB.DuPontR. L. (2014).
Patterns of abstinence or continued drug use among methadone maintenance patients and their relation to treatment retention. Journal of Psychoactive Drugs,
46(2), 114–122.
46.
WuF.PengC. Y.JiangH.ZhangR.ZhaoM.LiJ.HserY. I. (2012).
Methadone maintenance treatment in China: Perceived challenges from the perspectives of service providers and patients. Journal of Public Health,
35(2), 206–212.
